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Individual

MS. PRISCILLA JO GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD

Contact information

Practice address
351 RED ROCK ROAD, LOS CERRILLOS, NM 87010
(505) 274-8939
Mailing address
HC 63 BOX 30, PENA BLANCA, NM 87041-9701
(505) 274-8939

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0653
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LD-0653
SELF PAY
NM
Enumeration date
04/08/2019
Last updated
06/11/2019
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